Overview Join to apply for the Utilization Management Nurse - Home Solutions - Compact RN Required role at Humana . This range is provided by Humana. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.
Base pay range $71,100.00/yr - $97,800.00/yr
Become a part of our caring community and help us put health first Full-Time, Remote Telephonic opportunity
Role summary The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. As a Utilization Management RN working on the OneHome/Home Solutions UM Team, you will have the opportunity to use your clinical knowledge, communication skills, and independent critical thinking skills to ensure value-based care for members who desire to heal at home. In this role you will coordinate and communicate with providers, members, or other parties to facilitate optimal member care and treatment.
Responsibilities Help ensure fully coordinated care at home for our members.
Coordinate and communicate with providers, members, or other parties to facilitate optimal member care and treatment.
Support interpretation of clinical information and make recommendations to improve patient outcomes.
Navigate multiple systems and screens while working cases.
Collaborate with multiple internal and external parties.
Required Qualifications Minimum of Associate Degree in nursing
Licensed Registered Nurse (RN) in a compact state with no disciplinary action
Must have valid compact license or reside in a compact state and be eligible to upgrade to compact licensure
Three (3) or more years of progressive and varying clinical experience that includes direct patient care to geriatric population
Effective telephonic and virtual communication skills
Comprehensive knowledge of Microsoft Word, Outlook and Excel
Ability to work independently under general instructions and within a team
Preferred Qualifications Bachelor’s degree
Two (2) or more years of home health experience and/or utilization management experience
Experience in a managed care setting
Health Plan experience
CGX experience
Work-At-Home Requirements Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role).
A minimum standard speed for optimal performance is 25mbs download x 10mbs upload is required.
Check your internet speed at www.speedtest.net
A dedicated office space lacking ongoing interruptions to meet productivity requirements and protect member PHI / HIPAA information.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Work schedule Schedule: 40 hours per week
Pay and Benefits The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
Pay range: $71,100 - $97,800 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Benefits and About Us Humana offers competitive benefits that support whole-person well-being. Benefits include medical, dental and vision, 401(k) retirement savings plan, paid time off, holidays, volunteer time off, paid parental and caregiver leave, disability, life insurance and more. About OneHome: OneHome coordinates a full range of post-acute care services and was acquired by Humana in 2021. About Humana: Humana Inc. is committed to putting health first for teammates, customers, and the company.
Equal Opportunity Employer Humana does not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. Humana complies with Section 503 and VEVRAA to employ and advance in employment individuals with disability or protected veteran status, based on valid job requirements.
Seniority level Mid-Senior level
Employment type Full-time
Job function Health Care Provider
Industries Insurance
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